If you’re dealing with female infertility, there are many different tests that you’ll have done and things to know that maybe you’ve never heard of before.
For example, you might learn about AMH levels, which is likely something that, before your fertility journey, you didn’t know about.
As a woman, you’re born with anywhere from one to two million eggs, which is all you’ll ever have.
Then, beginning at your first period, your body recruits a group of follicles, each of which has an immature egg inside. Those follicles can respond to hormones and then grow and ovulate. You’ll typically ovulate a single egg per month. The eggs not selected for ovulation dissolve, and the cycle goes on if you aren’t pregnant.
Increasingly, women in the U.S. have children later in life, often because they want to establish their careers first. There are positives to that such as more financial stability, but as women, our fertility goes down as we age.
This is where AMH levels can be more relevant.
What Are AMH Levels?
AMH stands for anti-Mullerian hormone. This is a lab test that your fertility doctor or OB-GYN might use to assess your egg count or egg reserve.
The hormone is produced by your ovary follicles or, more specifically, by your granulosa cells located there.
The American College of Obstetricians and Gynecologists says the production of AMH reflects your ovarian reserve.
If you have a low AMH level, it can show that you might have a diminished ovarian reserve or a DOR. This is a way of saying a low egg count, so it’s an important hormone as far as fertility.
Testing AMH levels requires a blood test, and the level stays pretty stable throughout your cycle, so it shouldn’t matter when you take the test.
The lower limit of serum AMH in a 25-year-old is 3.0 ng/mL, and at 30, that goes up to 2.5 ng/mL. By the time you’re 35 it’s 1.5 ng/mL, 1 ng/mL at 40 and 0.5 ng/mL by 45.
These are estimates, and the cutoff limit can vary depending on the lab.
If you have an AMH level below 1.6 ng/mL it could predict lower numbers of eggs retrieved with IVF, and anything below 0.5 is severely deficient.
What Can the Test Tell You?
AMN levels aren’t going to give you any specific answers about your potential natural fertility. What the test can do is if you’re going through IVF, provide a prediction for how many eggs you might produce. The test can also help your health care provider know the dosage of medication you need to stimulate egg production.
If you weren’t dealing with an issue of infertility, the AMH test couldn’t tell you things like how long it may take you to conceive or make a prediction of infertility.
If you’re in the process of a workup for infertility, then AMH levels can help predict how the stimulations of your ovaries might progress.
Doctors will often come up with a measure of ovarian aging based on your chronologic age, your AMH, and your antral follicle count that they can see on an ultrasound.
How Does AMH Relate to Follicle Stimulating Hormone (FSH)?
FSH is something your pituitary gland makes that’s involved in your sexual development as well as your functioning. The FSH stimulates your eggs to grow, increasing estrogen and then progesterone.
If you have a higher FSH, it can mean you have a lower ovarian reserve, but inversely, a lower AMH shows a lower reserve.
AMH tends to be considered a more reliable test to determine ovarian reserve than FSH since your levels are consistent throughout your cycle.
What AMH Is Not
Some of these have been briefly touched on, but it’s worth reiterating the things that AMH is not.
First, it’s not a way to predict whether or not you can spontaneously get pregnant in the future. The only test for that is if you get pregnant.
One large study found no difference in rates of pregnancy in women with normal AMH values trying to conceive versus women with low AMH levels.
With that in mind, an AMH test gives you a bigger picture view of your fertility, and that can help you make empowered choices that are right for you.
In some cases, the AMH test can also be used for other purposes, like monitoring your health if you have certain kinds of ovarian cancer, predicting when menopause might start, or diagnosing menstrual disorders.